VAT EXEMPTION CERTIFICATE

The undersigned Dr.

As a Medical Surgeon, registered with the Register of Physicians and Dentists

CERTIFIES THAT
THE PATIENT

Patient Name

Date and Place to Birth

He underwent a medical examination today, providing all the information regarding his health status, as per his medical history in his medical records.
The patient's clinical evaluation resulted in the following diagnosis:

DIAGNOSIS

The patient is then nominated for a therapeutic path that includes the following treatment(s) and/or surgical intervention

TREATMENT

With the following therapeutic purpose(s), that is, aimed at protecting, maintaining, or restoring the state of health, including psychophysical health. In this specific case, after the visit with anamnesis and clinical examination, it is assessed that the intervention has the purpose of:

TREAT A FUNCTIONAL DISORDER

TREAT A SOMATIC, PSYCHO-PHYSICAL DISCOMFORT

DIAGNOSING OR TREAT ILLNESSES OR HEALTH PROBLEMS

PROTECTING, MAINTAINING, OR RESTORING HEALTH, INCLUDING PSYCHO-PHYSICAL HEALTH

NOTE

*SIGNATURE

PATIENT STATEMENT REGARDING HIS OR HER HEALTH STATUS

The undersigned, as patient, declares that he/she has expressed, without reservations, his/her state of health, allowing the doctor to carry out the clinical evaluation referred to in this certificate.

IN FAITH

*NAME AND SURNAME

*DATE

*EMAIL ADDRESS

*SIGNATURE

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